Measles-Associated Severe Pneumonia in a Patient with HBeAg-Negative Chronic Hepatitis B: A Case Report

Background: Every year, approximately 800,000 people die from liver diseases associated with hepatitis B virus (HBV) infection. Complications outside the liver are common, such as fungal lung infections and viral infections. These complications may be associated with poor immune function, thus making clinical treatment difficult and increasing the risk of death. Therefore, HBV-infection-related liver diseases are worthy of clinical attention and further research. Case summary: We report a case of HBeAg-negative chronic hepatitis B in which the patient received entecavir as an anti-HBV treatment after liver dysfunction. During the treatment, the patient was diagnosed with measles and severe viral pneumonia. After comprehensive treatment, including active antiviral medications and mechanical ventilation, the patient recovered and was discharged. Conclusion: HBV infection causes liver damage, affects immune function, and is likely to be associated with viral infections such as measles. Consequently, infections may lead to complications, such as severe viral pneumonia, that endanger patients’ lives. To decrease complications and mortality, better understanding of the disease is necessary to enable early diagnosis.

Large spontaneous HBV DNA fluctuations and potential usefulness of a single point measurement of combined HBV DNA and quantitative HBsAg for the exclusion of HBeAg negative chronic hepatitis B: A prospective Tunisian cohort study

Background/Aims: We aimed to describe spontaneous short-term hepatitis B Virus (HBV) DNA level fluctuations and to assess the usefulness of quantitative HBsAg (qHBsAg) in Tunisian patients with HBeAg-negative chronic HBV infection.Patients and methods: We included 174 treatment-naïve patients with chronic HBeAg-negative HBV. A one-year prospective follow-up was carried out with serial determinations of HBV DNA, alanine aminotransferase levels and qHBsAg. Patients were classified into three groups: inactive carriers (G1), patients with HBeAg negative chronic hepatitis B (CHB) (G2) and patients with indeterminate state (G3). For this latter group, a liver biopsy was indicated.Results: Only genotype D was detected. During the follow-up, 21.6% and 19.5% of patients with low initial (<2000 IU/mL) and intermediate viral load (2000-20000 IU/mL), experienced a subsequent increase in their HBV DNA levels above 2000 and 20000 IU/mL, respectively. Significant variations of HBV DNA levels (≥0.5 log10 IU/mL) were observed in 61.1% of patients at 6 months-interval. Among the 174 patients, 89 (51.1%) belonged to G1, 33 (19%) to G2 and 52 (29.9%) to G3. Fourteen patients have undergone liver biopsy, among whom 7 (50%) showed moderate to severe liver disease. Combination of HBV DNA <2000 IU/mL and qHBsAg <832 IU/mL excluded CHB in 98.4% of cases.Conclusions: This study highlights the large short-term HBV DNA fluctuations in Tunisian patients with HBeAg negative chronic HBV of genotype D. HBV DNA < 2000 IU/mL along with qHBsAg < 832 IU/mL excluded CHB in 98.4% of cases. Significant proportion of patients with indeterminate state within genotype D would have HBeAg negative CHB.

Discontinuation of nucleot(s)ide analogue therapy in HBeAg-negative chronic hepatitis B: a meta-analysis

Background and aimsSustained virological suppression and hepatitis B surface antigen (HBsAg) loss have been described after nucleot(s)ide analogue (NA) discontinuation for patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB). We performed a meta-analysis of the clinical outcomes after NA discontinuation for HBeAg-negative CHB.MethodsStudies involving NA cessation in HBeAg-negative CHB individuals with a median follow-up of ≥12 months were included. Participants were HBeAg-negative at the time of NA initiation. Random effects meta-analyses were performed for the following clinical outcomes: (1) virological relapse (VR) at 6 and 12 months; (2) clinical relapse (CR) at 6 and 12 months and (3) HBsAg loss. Effect of other variables was estimated using subgroup analysis and meta-regression. Studies including patients stopping entecavir (ETV) and/or tenofovir disoproxil fumarate (TDF) were considered separately to studies including patients stopping older generation NA.ResultsN=37 studies met inclusion criteria. Cumulative incidence of VR and CR after stopping ETV/TDF was 44% and 17% at 6 months and 63% and 35% at 12 months. Similar relapse rates were observed after stopping older NAs. Among patients stopping ETV/TDF, TDF cessation was associated with increased CR rates at 6 months versus ETV. There was an association between follow-up ≥4 years and HBsAg loss rates when stopping older NAs. Hepatic decompensation and hepatocellular carcinoma were rare but occurred more frequently in studies including cirrhotic individuals.ConclusionVR is common after NA discontinuation, however, CR was only seen in one-third of patients at 12 months. Stopping NA therapy can be followed by HBsAg clearance, and rates are higher with longer follow-up.

Biological Profile of Chronic Hepatitis B and its Predictive Factors According to Liver Histological Activity at the Renaissance Hospital, N’Djamena, Chad

Background: No study in black Africa has investigated the profile of chronic hepatitis B according to the new European association for the study of the liver (EASL) classification. The aim of the study was to determine the biological profile of chronic HBsAg carriers according to the EASL classification of chronic hepatitis B. Method: This is a prospective cross-sectional study carried out in the gastroenterology outpatient department at the Renaissance Hospital in N’Djamena from January, 2018 to July, 2019. All patients with chronic HBsAg were included and documented for at least one year. Patients with hepatitis C, hepatitis D or HIV or alcoholic were excluded. The biological profile was determined according the EASL classification: HBeAg-positive chronic infection, HBeAg-positive chronic hepatitis, HBeAg-negative chronic infection, HBeAg-negative chronic hepatitis and HBsAg-negative phase. Factors associated with presence of significant liver fibrosis were founded by logistical regression. Results: 106 patients were included. The average age were 42.4 years old. The sex ratio was 1.43. The median of the transaminase were 24 IU/ml (AST) and 21 IU/ml (ALT). 61 patients had HBeAg-negative chronic infection (59.8%) and 37 patients had HBeAg-negative chronic hepatitis (36.2%). HBeAg-positive chronic infection and HBeAg-positive chronic hepatitis were both seen in 2% of the cases. Significant liver fibrosis was independently associated with the ALT levels (Odds ratio=1.038 [1.009-1.068]; p=0.009). Conclusion: Chronic HBeAg-negative B infection is the main form in chronic HBsAg-positive carriers. Transaminases are a predictive factor for the presence of hepatic fibrosis.